A triple-blinded randomized trial comparing the hemostatic effects of large-dose 10% hydroxyethyl starch 264/0.45 versus 5% albumin during major reconstructive surgery

In Canada, hydroxyethyl starch 264/0.45 (HES 264/0.45; molar weight 264 kDa, molar substitution 0.45) has largely replaced albumin as the colloidal fluid of choice for perioperative intravascular volume expansion. The maximum recommended dose of HES 264/0.45 is 28 mL/kg; however, there are no clinical data supporting this limit. In this study we compared the hemostatic effects of HES 264/0.45 versus 5% albumin in doses up to 45 mL/kg over 24 h during major reconstructive head and neck surgery. Fifty patients were randomized to receive HES 264/0.45 or 5% human albumin from the induction of anesthesia until 24 h thereafter. Both albumin and HES 264/0.45 effectively maintained physiologic variables in the perioperative and postoperative periods. The partial thromboplastin time and international normalized ratio were significantly increased in the HES 264/0.45 group compared with the albumin group after infusion of 30 mL/kg and 45 mL/kg (P < 0.05). Factor VIII activity and von Willebrand factor level were significantly reduced in the HES 264/0.45 group compared with the albumin group after infusion of 15 mL/kg, 30 mL/kg, and 45 mL/kg (P < 0.05). Significantly more subjects in the HES 264/0.45 group received allogeneic red blood cell transfusions (P < 0.02). We conclude that HES 264/0.45 infusions >30 mL/kg over 24 h impair coagulation to a greater extent than albumin, possibly leading to more allogeneic transfusions.     

Society for the Social History of Medicine: Medicine and the emergence of modern warfare

Medicine and War

War and Public Health Edited by Barry S. Levy and Victor W. Sidel Oxford University Press in co‐operation with the American Public Health Association, 1997, 412 pp., £42.50, ISBN 0–19–510814–0

The Plague Makers: The Secret World of Biological Warfare By Wendy Barnaby Vision Paperbacks, London, 1997, 202 pp., £9.99, ISBN 1–901250–04–0

Plutonium and Highly Enriched Uranium 1996 World Inventories, Capabilities, and Policies By David Albright, Frans Berkhout, and William Walker SIPRI/Oxford University Press, Oxford, 1997, 502 + xxxii pp., £40.00, ISBN 0–19–828009–2.

Moruroa and Us By Pieter de Vries and Han Seur Centre de Documentation et de Recherche sur la Paix et les Conflits, Lyon, 1997, 224pp., Frs 152.05 inc. p&;p, ISBN 2–9508291–5–5, (available from CDRPC, BP 1027, 69201 Lyon, France).

Caring

Agency, Health and Social Survival: The Ecopolitics of Rival Psychologies By Caroline New Taylor and Francis, London, 1996, 184 pp., £39.00, ISBN 0–7484–0246–2 hbk., £12.95, 0–7484–024–0 pbk.

Who Cares? True Stories of the NHS Reforms By Peter Bruggen Jon Carpenter, Cbarlbury, Oxon, 1997, 314 pp., £12.00, ISBN 1–897766–32–7.

Sacred Journeys By Jennifer Westwood with forward by Martin Palmer Gaia Books, London, 1997, 223 pp., £14.99, ISBN 1–85675 ‐004–3.     

Does ‘Sports Massage’ Have a Role in Sports Medicine?

More and more athletes are turning to massage, apparently in hopes of gaining a winning edge. But although research does not support claims that massage improves performance, it can offer athletes some physiological and psychological benefits.     

Patients and families experiences with video telehealth in rural/remote communities in Northern Canada

Aim. To explore patients’ and families’ experiences with video telehealth consultations as a method of health care delivery in rural/ remote communities in Northern Canada. Background. Accessing health services in isolated populations where human resources and infrastructure are constrained by vast geographical landmasses poses challenges and opportunities for nurses, health care providers, patients and families. Design. A qualitative approach was adopted with a purposeful sample of 10 patients and four family members representative of nine communities. Method. Selection criteria included patients receiving telehealth visits for a minimum of a year and willing to share their experiences. Data were collected during the winter of 2006 using semi‐structured video taped interviews and analysed using a qualitative thematic content analysis. Results. Patients and families experiences of their telehealth visits centered on three key themes: lessening the burden (costs of travel, accommodations, lost wages, lost time and physical limitations), maximising supports (access to family, friends, familiar home environment, nurses and other care providers), tailoring specific e‐health systems to enhance patient and family needs. Conclusion. The benefits of telehealth extend not only to patients and families but are linked to benefits for providers as well as the health care system. Relevance to clinical practice. This study indicates that video telehealth is an effective mechanism for delivering nursing and other health services to rural/remote communities and can impact positively on the quality of health care. The integration of telehealth practice can enhance the coordination, organisation and implementation of health care services.     

A comparison of general and age-specific factors associated with political behavior

Abstract

Sociological research has focused on relationships between status, participation, efficacy, and political behavior with less attention to the influence of discontinuity in life circumstances on political activity. In contrast, gerontologists have explored the implications of age-specific and life change factors for political orientations but conflicting hypotheses have been derived. On suggests that discontinuity will decrease political activity while the other contends that discontinuity will politicize individuals This study compares the relative contribution of life change and age-specific factors, demographic characteristics, and efficacy to voting and political interest. Data were collected by personal interviews with a random sample of 169 inner and women 65 or over. Voting and political interest had somewhat different antecedents, but participation in multi-age groups and efficacy increased both while age-paded participation decreased political activity. Discontinuity, in general, had less effect on political behavior than empathic characteristics and efficacy.     

关注健康,没有借口——高寿糖尿病明星Louis Zorich的健康态度

<正>"不管存在多少借口,预防和控制糖尿病比出现并发症后再去补救要容易得多。"2008年11月的一次常规体检后,84岁高龄的美国著名演员Louis Zorich得知自己患上了糖尿病。     

Mental health,employment, and welfare tenure

This article determines the prevalence of mental health diagnosis and impairment among 632 participants in Temporary Assistance for Needy Families (TANF) and describes the relationship between these problems and welfare tenure and employment. A random sample of female TANF participants was surveyed in two California counties consecutively for 3 years, starting in 1999. TANF participants who have mental health problems are more likely than those who have none to leave welfare as a result of sanction and less likely to work at all. They also work fewer weeks in a year and fewer hours per week. In the course of 36 months, their earned income is substantially lower than that of those who do not have mental health problems. © 2005 Wiley Periodicals, Inc. J Comm Psychol 33: 587–609, 2005.